How to Prepare for Journal Club Helpful tips for residents and fellows to make a good journal club presentation

1. How to Prepare for JournalHow to Prepare for Journal
ClubClub
Ramin Nazari, MDRamin Nazari, MD
Pediatric Residency ProgramPediatric Residency Program
June 2016June 2016

2. Definition of journal club
 A journal club is a group of individual whoA journal club is a group of individual who
meet regularly to critically read,meet regularly to critically read,
understand and evaluate recent articlesunderstand and evaluate recent articles
published in medical or dental literature.published in medical or dental literature.

3.  The first mention of a journal club is found in the 1835-54
memories of British surgeon Sir James Paget.
 He reported that self-elect of pupils, making themselves into
a kind of club, had a small room over a baker’s shop near the
hospital gate where we could sit and read the journals’.
 Sir William Osler is widely credited as establishing the first
organized journal club at McGill University in 1875(Linzer,
1987).
 In 1996, professor Mattingly of Exeter university wrote one of
the first article about the journal clubs as an: Introduction to
the systemic use of medical literature for junior staff, and a
convenient method of surveying the medical literature for
senior staff.
Historical background of journal
club

4.  Since then Journal club widely used to keep abreast of
current literature.
 In the 1990s the concept of evidence base medicine
was introduced, defined as … the conscientious, explicit
and judicious use of current best evidence in making the
decision about the care of individual patients’ (Sackett et
al, 1996).
 The skill of critical appraisal and ability to use the current
base in medicine practice has evolved, with journal clubs
being integral to this process.
Historical background of journal
club

5. Why attend Journal Clubs?
 Journal club link research to clinical practice current medical
literature and act as a vehicle for the application of evidence-
based medicine through continuing medical education (Esisi,
2007; Leung et at, 2013).
 Journal clubs also allow academic debate and networking
between colleagues of varying seniority (Esisi, 2007). Regular
meetings to discuss and appraise the medical literature help
trainees to develop their critical appraisal skills. These skills
are increasingly seen as a requirement for specialist hospital
doctors and the ability to demonstrate them is assessed at
specialty training interviews (Picard et at, 201 0; Leung et at,
2013).
 By honing critical appraisal skills, competence is developed
and publications may follow in the form of 'letters to the editor’
or papers developing research ideas stimulated by the articles
reviewed

6. Characteristics of successful
journal clubs
 They are held at regular intervals (e.g. monthly)
 They are held at a set time convenient for the members
 Attendance is compulsory and an attendance
register is held
 The attending clinician share common clinical interests
 There is a nominated chairman, who possesses
research experience and is widely respected. His/her
role is to chair meetings as well as guide club members
in their choice of journal articles

7.  The club has a clear purpose which is agreed by the
members and is periodically reviewed
 The articles selected for discussion are aligned with the
agreed ‘overall aim’ of the club and of clinical relevance
to the members
 Original articles are the most frequent papers discussed
 The papers are read in good time before the meeting.
Circulating the subject matter by email or the internet are
effective ways to do this
 Food is available at the meetings; the provision of food
at meetings is widely reported to improve attendance.
Characteristics of successful
journal clubs

8. The benefit of a journal club
 Critical appraisal skills are developed
 Participants keep abreast of current medical literature
 Research literacy and evidence based practice are
developed
 The needs of continuing medical education are met
 Interviewing skills are developed
 Academic debate is a stimulator
 Interdepartmental social and professional networking
take place
 Publication are generated (e.g. letters to editor, further
research)

9. Common journal club goals
1.1. Providing participation with an update of medical orProviding participation with an update of medical or
dental literature.dental literature.
2.2. Teaching and learning the technique of criticalTeaching and learning the technique of critical
appraisal of available literature.appraisal of available literature.
3.3. Promoting the importance of valid research findings intoPromoting the importance of valid research findings into
regular practice at individual or community level.regular practice at individual or community level.

10. Paper SelectionPaper Selection
 Pick a good paperPick a good paper
 What makes a "good" J. Club paper?What makes a "good" J. Club paper?
 The article should be selected from a peer-reviewed,The article should be selected from a peer-reviewed,
well-respected journal in Pediatrics.well-respected journal in Pediatrics.
 Randomized controlled trials are best, although otherRandomized controlled trials are best, although other
types of studies such as cohorts, case-control studies,types of studies such as cohorts, case-control studies,
and meta-analyses can occasionally be chosen.and meta-analyses can occasionally be chosen.
 Case reports and review articles are not appropriate forCase reports and review articles are not appropriate for
this purpose and should be avoided.this purpose and should be avoided.
 Papers that present an important concept in a clearPapers that present an important concept in a clear
manner. Many excellent papers are published but themanner. Many excellent papers are published but the
data does not lend itself well to a clear presentation..data does not lend itself well to a clear presentation..

11. Paper SelectionPaper Selection
Overall features:Overall features:
 Should clearly state WHY doing the problem in the firstShould clearly state WHY doing the problem in the first
place (significance) – find in introduction, should be wellplace (significance) – find in introduction, should be well
referenced, shouldn't have to go to additional sourcesreferenced, shouldn't have to go to additional sources
unless need to check specifics.unless need to check specifics.
 Should clearly state WHAT is the problem to be solved –Should clearly state WHAT is the problem to be solved –
see introduction.see introduction.
 Should clearly state HOW the problem is to be solved –Should clearly state HOW the problem is to be solved –
see Experimental Procedures.see Experimental Procedures.
 Should clearly state the CONCLUSIONS of the paper –Should clearly state the CONCLUSIONS of the paper –
see Discussion.see Discussion.

12.  If you have been assigned a mentor forIf you have been assigned a mentor for
journal club, consult the mentor at least 2journal club, consult the mentor at least 2
weeks in advance and choose a paperweeks in advance and choose a paper
that is interesting to your mentor. Beforethat is interesting to your mentor. Before
you prepare your JC presentation, read ayou prepare your JC presentation, read a
good recent review on the topicgood recent review on the topic

14. Presenting of a journal
club

15. Step 1: introduction
 Explain the clinical question that prompted
you to consult the literature and what drew
you to the article.

16. Step 2: who wrote the paper?
 Consider the title of the paper, the authors and their
affiliated institutions(s). Are there any outstanding
features, e.g. a first study of its kind, a well—known
author or institution?
 What is the impact factor of the journal! What is the
circulation (i.e. regional, national or international) and
who is the readership?
 Try to ignore the abstract initially Reading the author's
stated conclusions before forming your own ideas about
the validity of the paper may influence your appraisal.

17. Step 3: the hypothesis
 What is the research question?
 Is it well constructed?
 Does it observe the four basic components (PICO) of: a
good research question?
 Population — who was studied?
 Intervention — what was the intervention tested?
 Control — what was the alternative that the intervention
was compared to?
 Outcome — what was the nature of the outcome
measured

18. Step 4: Appraise the evidence
base
 Read the key references and related papers. What is
already known on the subject? Is this correctly
presented? Is the hypothesis corrects? Is the question
relevant and important in the context of the existing
literature? What does the study contribute to the missing
literature?
 The introduction will usually contain a statement
validating the content of the article by placing it in the
context of the wider literature.
 For example, ‘Intervention ‘x’ has been shown to show
significant reduction in patient group ’y’. However, no
studies to date have assessed the effect of ‘x’ in patients
with a history of ‘z’.’

19. Step 5: Study design
 The study type: Is it appropriate to the research
question and the subject under investigation, e.g.
randomized controlled trial, case control, meta-analysis,
cross-sectional, descriptive
 The study population:
 Can the results of the study be translated to the general
population! Is the patient group representative of the
normal population? If not, is this addressed in the text
 Randomization: How are the participants allocated
into the groups?

20.  Bias: This refers to a flaw in impartiality that introduces
systematic error into the methodology and results of a
study
 Is the research method exposed to bias?
 Has randomization been used to reduce experimenter
bias?
 What form of blinding or masking has been used to
reduce experimental or observational bias?
 Inclusion and exclusion criteria: Are these
appropriate and clearly stated? Can you identify any
oversights that may affect the validity of the study?
Step 5: Study design

21. Step 6: is the method thorough?
 A flawed methodology will underline the validity of the results.
Consider the following:
 Was the method and approach to the study appropriately
diligent? Were processes consistent? Was follow up complete
and consistent in each group? What outcome measures were
used and were they appropriate?
 Are the statistical tools adopted suitable and correctly
interpreted by investigators?

22.  Have the authors made a power statement? What
significant level has been used ( P value)?
 Has the power of the study been stated, does it exceed
80%? Was a power analysis carried out?
 Was this before the study or post hoc? Is the study
sufficiently powered to eliminate the errors?
 Do the data exhibit low variability? What is the effect
size?
Step 6: is the method thorough?

23. Step7: Results
 Are the results clearly stated?
 Have any results been ignored and why? Is the result
statistically significant, i.e. Is the P value less than 0.05
(is the null hypothesis rejected)?
 Were results analyzed based on the intention-to-treat
principle?
 Remember to review supplementary graphs and tables
and consider whether they are accurate and represent
the data presented in the text.

24. Step 8: discussion and
Interpretation
 Discuss the strengths and weaknesses of the study. Do
the results support the conclusions?
 Often the conclusion will exceed the scope of the
evidence base in the preceding paper.
 Consider the statistical significance vs the clinical
significance? Does the article acknowledge the relevant
literature and other approaches?
 Before concluding, the authors will often include a
discussion of the limitations of the study. Close attention
should be paid to this to ensure a fair appraisal of the
author's claims.
 Have the authors declared any conflicts of interest?

25. Step 9: clinical context
 End your appraisal by assessing how the paper might
change clinical practice.
 You might refer back to the clinical question that first
drew you to the article.

26. Step 10: output
 Having critically appraised and presented the article,
consider whether your comments would be of interest to
the publishing journal in the form of a letter to the editor.
 Particular points of merit, in addition to inconsistencies or
statistical short failings, arc of interest to the journal, its
readership and the author. Writing letters to the editor is
a useful way to hone writing skills and. if accepted, are
often published quickly and enhance a CV. Often, the
article may suggest areas for further research.

28.  The goal of the presentation is not to provide a detailed
description of the article, because the audience should
have read the article ahead of time.
 Rather, the presentation should focus on refreshing the
audience’s memory by highlighting the main points.
 The remainder of the journal club can be spent appraising
the article with the group by discussing the strengths and
weaknesses, applicability of the results to one’s patients
and clinical practice, and future research that may be
needed to substantiate the findings.
 It is always helpful to ask faculty or experts in the field to
attend so that they can lend insightful comments to the
discussion.

29.  Finally, always remember to rehearse theFinally, always remember to rehearse the
presentation on your own ahead of time topresentation on your own ahead of time to
ensure a smooth delivery.ensure a smooth delivery.